<!DOCTYPE html>
<html lang="en">
<head>
    <meta charset="UTF-8">
    <meta name="viewport" content="width=device-width, initial-scale=1.0">
    <meta http-equiv="X-UA-Compatible" content="ie=edge">
    <title>Document</title>
    <link rel="stylesheet" href="bootstrap/css/bootstrap.css">
    <style>
        ul{display:block;margin:0;padding:0;list-style:none;}
li{display:block;margin:0;padding:0;list-style: none;}
img{border:0;}
    .place{height:40px; background:url(images/righttop.gif) repeat-x;}
.place span{line-height:40px; font-weight:bold;float:left; margin-left:12px;}
.placeul li{float:left; line-height:40px; padding-left:7px; padding-right:12px; background:url(images/rlist.gif) no-repeat right;}
.placeul li:last-child{background:none;}
    </style>
    </head>
    <body>
    <div class="place"> <span>位置：</span>
      <ul class="placeul">
        <li><a href="index.html">首页</a></li>
        <li>信息列表</li>
      </ul>
    </div>
        <div>
            
            <div class="panel panel-info" >
                  <div class="panel-heading">
                        <h3 class="panel-title">老人信息录入</h3>
                  </div>
                  <div class="panel-body">
                        <form class="form-horizontal" role="form" action="http://localhost:8080/resthome/InfoEntryServlet" method="POST">
                                <div class="form-group">
                                  <label for="firstname" class="col-sm-1 control-label">姓名</label>
                                  <div class="col-sm-2">
                                    <input type="text" class="form-control" name="name" placeholder="请输入名字">
                                  </div>
                                  <label for="firstname" class="col-sm-1 control-label">用户编号</label>
                                  <div class="col-sm-2">
                                        <input type="text" class="form-control" name="user_id" placeholder="用户编号">
                                </div>
                                </div>
                                <div class="form-group">
                                        <label for="firstname" class="col-sm-1 control-label">身份证号</label>
                                        <div class="col-sm-4">
                                          <input type="text" class="form-control" name="IDcard" placeholder="请输入身份证号">
                                        </div>
                                        <label for="firstname" class="col-sm-1 control-label">年龄</label>
                                        <div class="col-sm-1">
                                              <input type="text" class="form-control" name="age" >
                                      </div>
                                      <label for="firstname" class="col-sm-1 control-label">性别</label>
                                      <div class="col-sm-1">
                                            <select class="form-control " name="sex">
                                                    <option value='1'>男</option>
                                                    <option value='0'>女</option>
                                                  </select>
                                    </div>
                                      </div>
                                      <div class="form-group">
                                            <label for="firstname" class="col-sm-1 control-label">电话号码</label>
                                            <div class="col-sm-3">
                                              <input type="text" class="form-control" name="telephone" placeholder="请输入电话号码">
                                            </div>
                                            <label for="firstname" class="col-sm-1 control-label">入住类型</label>
                                            <div class="col-sm-4">
                                                    <label class="radio-inline">
                                                            <input type="radio" name="check_in_style" id="optionsRadios3" value="试住" checked> 试住
                                                        </label>
                                                        <label class="radio-inline">
                                                            <input type="radio" name="check_in_style" id="optionsRadios4"  value="商住"> 商住
                                                        </label>
                                                        <label class="radio-inline">
                                                                <input type="radio" name="check_in_style" id="optionsRadios3" value="短住" checked> 短住
                                                            </label>
                                                            <label class="radio-inline">
                                                                <input type="radio" name="check_in_style" id="optionsRadios4"  value="长住"> 长住
                                                            </label>
                                                  </div>
                                                  <label for="firstname" class="col-sm-1 control-label">居住方式</label>
                                            <div class="col-sm-2">
                                                    <label class="radio-inline">
                                                            <input type="radio" name="living_style" id="optionsRadios3" value="拼房" checked> 拼房
                                                        </label>
                                                        <label class="radio-inline">
                                                            <input type="radio" name="living_style" id="optionsRadios4"  value="包房"> 包房
                                                        </label>
                                                      
                                                  </div>
                                          </div>
                                          <div class="form-group ">
                                                <label for="firstname" class="col-sm-1 control-label">入住时间</label>
                                                <div class="col-sm-2 ">
                                                  <input type="date" class="form-control " id="firstname" name="check_in_time_f">
                                                </div>

                                              <label for="firstname" class="col-sm-1 control-label">餐饮类型</label>
                                              <div class="col-sm-2">
                                                    <select class="form-control " name="food_type">
                                                            <option value="普食">普食</option>
                                                            <option value="营养餐">营养餐</option>
                                                          </select>
                                            </div>
                                            <label for="firstname" class="col-sm-1 control-label">护理级别</label>
                                            <div class="col-sm-2">
                                                  <select class="form-control " name="nursing_level">
                                                          <option value="自理">自理</option>
                                                          <option value="介护">介护</option>
                                                          <option value="介助">介助</option>
                                                        </select>
                                          </div>
                                              </div>
                                              <div class="form-group ">
                                                    <label for="firstname" class="col-sm-2 control-label">合同开始时间</label>
                                                    <div class="col-sm-2 ">
                                                      <input type="date" class="form-control " id="firstname" name="s_date_f" >
                                                    </div>
                                                    <label for="firstname" class="col-sm-2 control-label">合同结束时间</label>
                                                    <div class="col-sm-2 ">
                                                      <input type="date" class="form-control " id="firstname"  name="e_date_f">
                                                    </div>
                                                </div>
                                                <div class="form-group ">
                                                        <label for="firstname" class="col-sm-1 control-label">价格体系</label>
                                                       <div class="col-sm-2">
                                                      <select class="form-control " name="price_system">
                                                          <option value="2018价格体系">2018价格体系</option>
                                                          <option value="2018价格体系"> 2019价格体系</option>
                                                        </select>
                                                      
                                                        </div>
                                                        <label for="firstname" class="col-sm-offset-2 col-sm-1 control-label">房间号</label>
                                                        <div class="   col-sm-2">
                                                                <input type="text" class="form-control" placeholder="请输入房间号" name="number"> 
                                                         </div>
                                                    </div>
                                                    <div class="form-group ">
                                                            <label for="firstname" class="col-sm-1 control-label">备注:</label>
                                                            <div class="   col-sm-8">
                                                           <textarea name="" id="input" class="form-control" rows="3" name="remakes"></textarea>
                                                           </div>
                                                        </div>
                                <div class="form-group" style="padding:50px 0px;">
                                    
                                </style>>
                                  <div class="col-sm-offset-8 col-sm-3">
                                    <button type="submit" class="btn btn-primary btn-lg">信息录入</button>
                                    <button type="submit" class="btn btn-success btn-lg">重置</button>
                                  </div>
                                </div>
                              </form>
                  </div>
            </div>
            

        </div>
</body>
</html>